MANAGEMENT OF HYPERKALEMIA IN VLBW INFANTS

1. Maintenance fluids: 80-100 cc/kg/day D5W. If blood sugar is >100 mg%, begin regular insulin infusion in normal saline (20 Units regular insulin in 100ml NS), 0.1 units/kg/hour (=0.5cc/kg/hr). Titrate infusion rate to keep blood sugar 100-200 mg%.
2. Blood sugar should be monitored every hour until stable, then every two hours. If blood sugar >200 mg%, or if serum potassium continues to rise, increase insulin infusion rate by 0.05U/kg/hr (=0.25cc/kg/hr). If blood sugar falls to <100 mg%, insulin infusion should be stopped. Any changes in insulin infusion rate should be followed by a blood sugar within one hour.
3. Additional treatment for hyperkalemia:

• Sodium bicarbonate, 1-3 mEq/kg IV over 3-5 minutes;
• Calcium gluconate (10%), 0.3-0.5 cc/kg IV over 2-5 minutes.

NOTE: Calcium gluconate is not compatible with sodium bicarbonate.

Algorithm for the Management of Hyperkalemia in Extremely Low Birthweight Infants

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